Title

* Credit Check Authorization

During your mortgage loan application process, this institution performs a Credit Check that requires us to obtain and confirm information regarding our personal and financial background. The Credit Check includes, but is not limited to, your marital status, number of dependents, current and past employers, current deposit accounts, current and past consumer credit accounts, and your mortgage and/or rental history.

We Authorize this Credit Check

* Patriot Act Agreement

In accordance with Federal regulations set forth in the USA Patriot Act, this institution is required to verify the identity of any person applying for a mortgage loan to the extent reasonable and practicable, and maintain records of the information used to verify their identity. During your mortgage loan application process, we will require your name, current and past home addresses, date of birth, and other identifying information about you.

I AGREE to these terms

* Authorization to Receive
Electronic Disclosures

In order to successfully process your mortgage loan application, you must agree to receive certain disclosures from this institution in electronic form rather than paper form. You must also agree to the terms of the eDisclosure Agreement, which include software and hardware requirements and you responsibility to maintain and provide a valid email address. Certain disclosures may be provided to you in paper form as necessary once your mortgage loan application is received.

I AGREE

Personal Info

Borrower

Borrower SSN*:

Borrower first name*:

Borrower middle name:

Borrower last name*:

Borrower Name Suffix:

Borrower yrs. school:

Marital status*:

Number of Dependents*:

Dependents age:

Completed*:

JointlyNot jointly

Date of Birth*:

Co-Borrower

Co-Borrower SSN:

Co-Borrower first name:

Co-Borrower middle name:

Co-Borrower last name:

Co-Borrower Name Suffix:

Co-Borrower yrs. school:

Marital status:

Number of Dependents:

Dependents age:

Completed:

JointlyNot jointly

Date of Birth:

Present Address

Borrower

Street*:

City*:

State*:

Current Zip Code*:

You Currently*:

Years at Address*:

Months at Address*:

Co-Borrower

Street:

City:

State:

Current Zip Code:

You Currently:

Years at Address:

Months at Address:

Mailing Address

Borrower

Street:

City:

State:

Country:

Zip Code:

You Currently:

Years at Address:

Months at Address:

Co-Borrower

Street:

City:

State:

Country:

Zip Code:

You Currently:

Years at Address:

Months at Address:

Former Address

Complete if you have lived at present address less than two years

Borrower

Street:

City:

State:

Zip Code:

You Were:

Years at Address:

Months at Address:

Co-Borrower

Street:

City:

State:

Zip Code:

Co-Borrower Was:

Years at Address:

Months at Address:

Subject Property

Street*:

City*:

State*:

Zip Code*:

Number of Units*:

Purpose of Loan*:

Property Will Be*:

Complete this part if this is construction or construction-permanent loan.

Year lot acquired:

Original Cost:

Amount Existing Liens:

(a)Present Value of Lot:

(b)Cost of Improvements:

Complete this part if this is a refinance loan.

Purpose of Loan:

Year acquired:

Original Cost:

Amount Existing Liens:

Improvements Are:

MadeTo Be Made

Describe Improvements:

Cost ($):

Complete this part if you've selected other purpose of loan.

Other Explanation:

Complete this part if you've selected other purpose of loan.

Title will be held in what Name(s):

Manner in which Title will be held:

Estate will be held in:

Fee SimpleLeasehold

Complete this line if estate will be held in leasehold.

Leasehold expiration date:

Down Payment Information

Down Payment Type Code:

Down Payment Amount:

Down Payment Explanation:

Type of Mortgage and Terms of Loan

Mortgage Applied for:

Other Explanation:

Amount*:

Interest Rate:

Number of Months:

Amortization Type:

Other Explanation:

Current Employer

Borrower

Employer name*:

Employer street address*:

Employer city*:

Employer state*:

Zip Code*:

Business Phone*:

Are You Self-Employed*:

YesNo

Years on job*:

Months on job*:

Years on this profession*:

Your current position or type of business*:

Co-Borrower

Employer name:

Employer street address:

Employer city:

Employer state:

Zip Code:

Business Phone:

Is Your Co-Borrower Self-Employed:

YesNo

Years on job:

Months on job:

Years on this profession:

Co-Borrower's current position or type of business:

If employed in current position less than two years or currently employed in more than one position complete the following

Borrower

Employer name:

Employer street address:

Employer city:

Employer state:

Zip Code:

Business Phone:

Are You Self-Employed:

YesNo

Dates (from):

Dates (to):

Monthly Income:

Your previous position or type of business:

Co-Borrower

Employer name:

Employer street address:

Employer city:

Employer state:

Zip Code:

Business Phone:

Is Your Co-Borrower Self-Employed:

YesNo

Dates (from):

Dates (to):

Monthly Income:

Your previous position or type of business:

Monthly Housing Expenses

Present Housing Expense

Rent:

First Mortgage (P&I):

Other Financing (P&I):

Hazard Insurance:

Real Estate Taxes:

Mortgage Insurance:

Homeowner Assn. Dues:

Other:

Proposed Housing Expense

First Mortgage (P&I):

Other Financing (P&I):

Hazard Insurance:

Real Estate Taxes:

Mortgage Insurance:

Homeowner Assn. Dues:

Other:

Monthly Income Information

Gross Monthly Income Borrower

Base Income*:

Overtime:

Bonuses:

Comissions:

Dividends/Interest:

Co-Borrower

Base Income:

Overtime:

Bonuses:

Comissions:

Dividends/Interest:

Other Income

Borrower

Other Income 1:

Income Amount:

Other Income 2:

Income Amount:

Other Income 3:

Income Amount:

Co-Borrower

Other Income 1:

Income Amount:

Other Income 2:

Income Amount:

Other Income 3:

Income Amount:

Checking, Savings and Credit Union Accounts

1. Account/Asset Type:

Name of Bank or Credit Union:

Account Number:

Balance or Value $:

2. Account/Asset Type:

Name of Bank or Credit Union:

Account Number:

Balance or Value $:

3. Account/Asset Type:

Name of Bank or Credit Union:

Account Number:

Balance or Value $:

Stocks, Bonds, and Mutual Funds

1. Asset Type:

Name of Institution:

Value $:

2. Asset Type:

Name of Institution:

Value $:

3. Asset Type:

Name of Institution:

Value $:

Additional Equities

1. Asset Type:

Name of Institution:

Value $:

2. Asset Type:

Name of Institution:

Value $:

Additional Assets (Including Life Insurance and Vested Retirement Funds)

Life Insurance Net Cash Value:

Face Amount:

Vested Retirement Funds:

Automobiles

Year:

Make:

Value:

Year:

Make:

Value:

Year:

Make:

Value:

Liabilities and Pledged Assets

List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real-estate loans, alimony, child support, stock pledges, etc. Use continuation sheet if necessary. Indicate those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.

1. Name of Creditor:

Type of Liability:

Monthly Payment:

Unpaid Balance:

2. Name of Creditor:

Type of Liability:

Monthly Payment:

Unpaid Balance:

3. Name of Creditor:

Type of Liability:

Monthly Payment:

Unpaid Balance:

4. Name of Creditor:

Type of Liability:

Monthly Payment:

Unpaid Balance:

Additional Payments - (if applicable)

Alimony Payment:

Child Support Payment:

Separate Maintenance Payment:

Job Related Expense:

Liabilities and Pledged Assets

Please include your Primary Residence on the Schedule of Real Estate.

Property Disposition:

Property Street:

Property City:

Property State:

Property Zip Code:

Present Market Value:

Gross Rental Income:

Insurance, Maint., Misc.:

Mortgage and Loan Information.

	Borrower	Co-Borrower
a. Are there any outstanding judgments against you?	YesNo	YesNo
b. Have you been declared bankrupt within the last seven years?	YesNo	YesNo
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last seven years?	YesNo	YesNo
d. Are you a party to a lawsuit?	YesNo	YesNo
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee.)	YesNo	YesNo
f. Are you presently delinquent or in default on any federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?	YesNo	YesNo
g. Are you obligated to pay alimony, child support, or separate maintenance?	YesNo	YesNo
h. Is any part of the down payment borrowed?	YesNo	YesNo
i. Are you a co-maker or endorser on a note?	YesNo	YesNo
j. Are you a U.S. citizen?	YesNo	YesNo
k. Are you a permanent resident alien?
l. Do you intend to occupy the property as your primary residence?	YesNo	YesNo
m. Have you had an ownership interest in a property in the last three years? (If Yes, please complete questions 1 and 2 below.)	YesNo	YesNo
1. What type of property did you own?
2. How did you hold title to the home?

If you answered yes to any questions A through I above, explain in the box below.

* Credit Check Authorization

We Authorize this Credit Check

* Patriot Act Agreement

I AGREE to these terms

* Authorization to Receive
Electronic Disclosures

I AGREE

Online Application

First Name:

Last Name:

Email:

Home Phone:

Cell Phone:

Personal Info

Borrower

Borrower SSN*:

Borrower first name*:

Borrower middle name:

Borrower last name*:

Borrower Name Suffix:

Borrower yrs. school:

Marital status*:

Number of Dependents*:

Dependents age:

Completed*:

JointlyNot jointly

Date of Birth*:

Co-Borrower

Co-Borrower SSN:

Co-Borrower first name:

Co-Borrower middle name:

Co-Borrower last name:

Co-Borrower Name Suffix:

Co-Borrower yrs. school:

Marital status:

Number of Dependents:

Dependents age:

Completed:

JointlyNot jointly

Date of Birth:

Present Address

Borrower

Street*:

City*:

State*:

Current Zip Code*:

You Currently*:

Years at Address*:

Months at Address*:

Co-Borrower

Street:

City:

State:

Current Zip Code:

You Currently:

Years at Address:

Months at Address:

Mailing Address

Borrower

Street:

City:

State:

Country:

Zip Code:

You Currently:

Years at Address:

Months at Address:

Co-Borrower

Street:

City:

State:

Country:

Zip Code:

You Currently:

Years at Address:

Months at Address:

Former Address

Complete if you have lived at present address less than two years

Borrower

Street:

City:

State:

Zip Code:

You Were:

Years at Address:

Months at Address:

Co-Borrower

Street:

City:

State:

Zip Code:

Co-Borrower Was:

Years at Address:

Months at Address:

Subject Property

Street*:

City*:

State*:

Zip Code*:

Number of Units*:

Purpose of Loan*:

Property Will Be*:

Complete this part if this is construction or construction-permanent loan.

Year lot acquired:

Original Cost:

Amount Existing Liens:

(a)Present Value of Lot:

(b)Cost of Improvements:

Complete this part if this is a refinance loan.

Purpose of Loan:

Year acquired:

Original Cost:

Amount Existing Liens:

Improvements Are:

MadeTo Be Made

Describe Improvements:

Cost ($):

Complete this part if you've selected other purpose of loan.

Other Explanation:

Complete this part if you've selected other purpose of loan.

Title will be held in what Name(s):

Manner in which Title will be held:

Estate will be held in:

Fee SimpleLeasehold

Complete this line if estate will be held in leasehold.

Leasehold expiration date:

Down Payment Information

Down Payment Type Code:

Down Payment Amount:

Down Payment Explanation:

Type of Mortgage and Terms of Loan

Mortgage Applied for:

Other Explanation:

Amount*:

Interest Rate:

Number of Months:

Amortization Type:

Other Explanation:

Current Employer

Borrower

Employer name*:

Employer street address*:

Employer city*:

Employer state*:

Zip Code*:

Business Phone*:

Are You Self-Employed*:

YesNo

Years on job*:

Months on job*:

Years on this profession*:

Your current position or type of business*:

Co-Borrower

Employer name:

Employer street address:

Employer city:

Employer state:

Zip Code:

Business Phone:

Is Your Co-Borrower Self-Employed:

YesNo

Years on job:

Months on job:

Years on this profession:

Co-Borrower's current position or type of business:

If employed in current position less than two years or currently employed in more than one position complete the following

Borrower

Employer name:

Employer street address:

Employer city:

Employer state:

Zip Code:

Business Phone:

Are You Self-Employed:

YesNo

Dates (from):

Dates (to):

Monthly Income:

Your previous position or type of business:

Co-Borrower

Employer name:

Employer street address:

Employer city:

Employer state:

Zip Code:

Business Phone:

Is Your Co-Borrower Self-Employed:

YesNo

Dates (from):

Dates (to):

Monthly Income:

Your previous position or type of business:

Monthly Housing Expenses

Present Housing Expense

Rent:

First Mortgage (P&I):

Other Financing (P&I):

Hazard Insurance:

Real Estate Taxes:

Mortgage Insurance:

Homeowner Assn. Dues:

Other:

Proposed Housing Expense

First Mortgage (P&I):

Other Financing (P&I):

Hazard Insurance:

Real Estate Taxes:

Mortgage Insurance:

Homeowner Assn. Dues:

Other:

Monthly Income Information

Gross Monthly Income Borrower

Base Income*:

Overtime:

Bonuses:

Comissions:

Dividends/Interest:

Co-Borrower

Base Income:

Overtime:

Bonuses:

Comissions:

Dividends/Interest:

Other Income

Borrower

Other Income 1:

Income Amount:

Other Income 2:

Income Amount:

Other Income 3:

Income Amount:

Co-Borrower

Other Income 1:

Income Amount:

Other Income 2:

Income Amount:

Other Income 3:

Income Amount:

Checking, Savings and Credit Union Accounts

1. Account/Asset Type:

Name of Bank or Credit Union:

Account Number:

Balance or Value $:

2. Account/Asset Type:

Name of Bank or Credit Union:

Account Number:

Balance or Value $:

3. Account/Asset Type:

Name of Bank or Credit Union:

Account Number:

Balance or Value $:

Stocks, Bonds, and Mutual Funds

1. Asset Type:

Name of Institution:

Value $:

2. Asset Type:

Name of Institution:

Value $:

3. Asset Type:

Name of Institution:

Value $:

Additional Equities

1. Asset Type:

Name of Institution:

Value $:

2. Asset Type:

Name of Institution:

Value $:

Additional Assets (Including Life Insurance and Vested Retirement Funds)

Life Insurance Net Cash Value:

Face Amount:

Vested Retirement Funds:

Automobiles

Year:

Make:

Value:

Year:

Make:

Value:

Year:

Make:

Value:

Liabilities and Pledged Assets

1. Name of Creditor:

Type of Liability:

Monthly Payment:

Unpaid Balance:

2. Name of Creditor:

Type of Liability:

Monthly Payment:

Unpaid Balance:

3. Name of Creditor:

Type of Liability:

Monthly Payment:

Unpaid Balance:

4. Name of Creditor:

Type of Liability:

Monthly Payment:

Unpaid Balance:

Additional Payments - (if applicable)

Alimony Payment:

Child Support Payment:

Separate Maintenance Payment:

Job Related Expense:

Liabilities and Pledged Assets

Please include your Primary Residence on the Schedule of Real Estate.

Property Disposition:

Property Street:

Property City:

Property State:

Property Zip Code:

Present Market Value:

Gross Rental Income:

Insurance, Maint., Misc.:

Mortgage and Loan Information.

	Borrower	Co-Borrower
a. Are there any outstanding judgments against you?	YesNo	YesNo
b. Have you been declared bankrupt within the last seven years?	YesNo	YesNo
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last seven years?	YesNo	YesNo
d. Are you a party to a lawsuit?	YesNo	YesNo
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee.)	YesNo	YesNo
f. Are you presently delinquent or in default on any federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?	YesNo	YesNo
g. Are you obligated to pay alimony, child support, or separate maintenance?	YesNo	YesNo
h. Is any part of the down payment borrowed?	YesNo	YesNo
i. Are you a co-maker or endorser on a note?	YesNo	YesNo
j. Are you a U.S. citizen?	YesNo	YesNo
k. Are you a permanent resident alien?
l. Do you intend to occupy the property as your primary residence?	YesNo	YesNo
m. Have you had an ownership interest in a property in the last three years? (If Yes, please complete questions 1 and 2 below.)	YesNo	YesNo
1. What type of property did you own?
2. How did you hold title to the home?

If you answered yes to any questions A through I above, explain in the box below.

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